Tuesday, October 27, 2015

In my opinion, it is bad enough that Foley (urinary) catheters are overused and that urinalysis and urine cultures are ordered indiscriminately with little understanding of how to interpret the results. To further complicate matters, urine samples on catheterized patients are frequently collected in a suboptimal fashion, as suggested by this article recently published in the American Journal of Infection Control.

In this study, 76% of nurses surveyed reported receiving education on catheter associated UTI (CAUTI) risk reduction within the last
12 months. Strikingly, 327 (83%) of all nurses surveyed reported that they
never collect urine samples by draining directly from the drainage bag, yet only
58% viewed others to be fully compliant with that standard.Improperly collected urine sample will lead to incorrect diagnostic and management decisions.The overuse of urinary catheters is rampant. Besides ongoing education on urinary catheter use, the effect of which dissipates typically in 6 months, automated mechanisms for daily review and automatic discontinuation orders to limit catheter use are the most consistent and evidence based mechanisms to minimize CAUTIs.It is to remove the urinary catheters in a consistent and formalized approach.

Tuesday, October 20, 2015

The BIG- LoVE study (Utah- Better Identification of Germs-Longitudinal Viral Epidemiology)- kudos for the catchy acronym, rather clever indeed, especially from a state (Utah) with a prior history of polygamy.

The article can be accessed here and was published in Clinical Infectious Diseases.

The investigators assessed the viral etiology of respiratory
illness by prospectively collecting weekly symptom diaries and nasal swabs for PCR analysis from
families for 1 year, analyzed data by reported symptoms, virus, age, and
family composition, and evaluated the duration of virus detection.

Participants reported symptoms in 23% and a virus was
detected in 26% of person-weeks. There were 783 viral detection episodes; 440 (56%) associated
with symptoms. Coronaviruses, human metapneumovirus, and influenza A. Viral detections
were usually symptomatic; bocavirus and rhinovirus detections were often
asymptomatic. The mean duration of PCR detection was ≤2 weeks for all viruses
and detections of ≥3 weeks occurred in 16% of episodes. Younger children had
longer durations of PCR detection.

So viral detection is common and often asymptomatic. Again, we need to resist using anti-infectives when not warranted. If it is not Influenza- no oseltamavir. Also, if the the clinical presentation is of a viral upper respiratory infection, no antibiotics!Eventually we will need better diagnostics, one that can detect pathogens and the concomitant inflammatory response, to differentiate between infection versus asymptomatic shedding.

Wednesday, October 14, 2015

Her are two media highlights on our recent JAMA Internal Medicine commentary, first authored by Dr. Michelle Doll.The first was published in Reuters, accessible here.The next, a podcast featuring Dr. Curtis Donskey and VCU's Dr. Michelle Doll, is accessible here.Click here for the my blog entry on the invited commentary.

Tuesday, October 13, 2015

Removal of personal protective equipment (PPE) can be risky business as highlighted in this hot off the press article in JAMA Internal Medicine. When assessed for the appropriate removal of PPE (gowns and gloves), over 40% of HCWs contaminated themselves through poor technique.We wrote the accompanying commentary to this article, accessible here. Dr.Michelle Doll elegantly argues in favor of selective use of contact precautions, with improved PPE, calling for enhanced mechanisms of training, evaluation and feedback of healthcare worker donning and doffing of gloves and gowns. To be effective, this must be done to scale, across the hospital environment. This is our charge and we moving forward. More to come.

Monday, October 12, 2015

It all comes down to implementation!
Those at VCU know that I have been saying this over and over and over, sounding much like a broken record.

Chlorhexidine patient bathing only works if done correctly, as summarized in this paper. The authors utilized a calorimetric assessment tool to assess chlorhexidine concentrations on patient skin following a chlorhexidine bath. The intervention was education of nursing and patients along with monitoring and feedback of bathing performance. Detection of chlorhexidine on patient skin went from a baseline of 46% to 88% following the intervention.Perhaps there are easier ways to measure completion of chlorhexidine bathing in hospitalized patients. Considerations include product consumption analyses and assessment of bathing documentation in the electronic medical record. These methodologies unfortunately do not measure detectable chlorhexidine concentrations in the skin. Challenging.It all comes down to implementation.

Saturday, October 10, 2015

Highlights include meetings and project planning with my colleagues from the SHEA Guidelines committee, presenting a poster and attending some truly superb scientific presentations, including a pro/con debate on bare below the elbows as an infection prevention recommendation.

Thursday, October 1, 2015

Dr. Ana Sanchez was invited on the Behalf of the VCU
GlobalHealth and Health Disparities Program (GH2DP) - Honduras
Program. Dr. Sanchez has collaborated with VCU GH2DP on reducing the burden of
soil transmitted helminths in rural Honduran populations. The lecture also covered the immunologic and health impact of helminthic infections in resource poor settings.

We were honored to have her visit VCU and to share both her research and our collaborative experience in a Medical Grand Rounds format.

Here is the VCU News article on the event.Phenomenal lecture, excellent turnout.